Provider Demographics
NPI:1760122972
Name:GORHAM PSYCHOTHERAPY PC DBA TOWNSEND THERAPY SERVICES
Entity Type:Organization
Organization Name:GORHAM PSYCHOTHERAPY PC DBA TOWNSEND THERAPY SERVICES
Other - Org Name:TOWNSEND THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-840-2303
Mailing Address - Street 1:820 W DANFORTH RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5006
Mailing Address - Country:US
Mailing Address - Phone:405-930-3389
Mailing Address - Fax:405-930-3398
Practice Address - Street 1:820 W DANFORTH RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5006
Practice Address - Country:US
Practice Address - Phone:405-930-3389
Practice Address - Fax:405-930-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty